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Postpartum depression in pediatric practice

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Dr Swati Y Bhave, Adjunct Professor in Adolescent Medicine; Dr D Y Patil Medical College, & Dr D Y Patil Vidyapeeth, Pune; Sr. consultant, Adolescent Pediatrics & Head-In-charge of Adolescent Wellness Clinic, Jehangir Hospital Pune    11 December 2022

Maternal health has a significant effect on the physical and mental well-being of the child. Postpartum depression is a frequent and debilitating obstetric complication. Maternal depression that remains undiagnosed and untreated adversely impacts the health of the mother as well as her child, including the families. Significant growth of the brain occurs during the early years. Hence, postpartum depression has a negative impact on development of the infant brain manifesting as cognitive or developmental delays.

 

Being the primary caregivers for children, pediatricians are uniquely placed to help mothers. The American Academy of Pediatrics (AAP) therefore, in a policy statement, recommends that “pediatricians screen mothers for postpartum depression at baby’s one-, two-, and four- and 6-month visits”. The guideline clearly enunciates that screening is not diagnostic and is merely indicative of the risk. Nevertheless, it calls for pediatricians to be vigilant and routinely screen for postpartum depression in their practice. The 10-question Edinburgh Postpartum Depression Scale (EPDS), completed by the mother, is recommended as the screening instrument. A score of ≥10 suggests “possible depression". A two-question screen can also be used to screen the mother.1

 

In a recent study published in the journal Clinical PediatricsLamere and Golova retrospectively examined the effect of a program that employed the EPDS for routine screening of postpartum depression at the Well Child visits as recommended by the AAP. A total of 224 women participated in this study.2 A significant increase in screening rates was observed in all four Well Child visits in the program. Mothers who had a history of a mental health disorder were more likely to screen positive on the EPDS. Mothers who had experienced recent food or housing insecurity or homelessness also had higher probability of a positive EPDS screen.

 

This study illustrates the successful screening of postpartum depression in a pediatric clinic by using the EPDS. It also re-affirms the role of pediatricians in screening for postpartum depression in mothers during the scheduled Well Child visits and refer them timely for appropriate evaluation and treatment. For this, AAP advocates availability of training programs for pediatricians in screening and referral for postpartum depression.

 

References

 

  1. Earls MF, et al. Incorporating recognition and management of perinatal and postpartum depression into pediatric practice. Pediatrics. 2019 Jan;143(1):e20183259. doi: 10.1542/peds.2018-3259.
  2. Lamere K, Golova N. Screening for postpartum depression during infant well child visits: a retrospective chart review. Clin Pediatr (Phila). 2022 Oct;61(10):699-706

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